Advanced Virtual Mentoring of Dentists in Oral Cancer Screening and Tobacco Cessation - An Interventional Study

Context: Oral cancer is the third common cancer in India. Its mortality can be reduced through early detection and tobacco cessation ideally by dentists owing to their forte of work. Aim: This study was conducted to discuss effectiveness of an advanced tele?mentoring programme in oral cancer screening and tobacco cessation for dentists across India. Settings and Design: Online, interventional study. Methods and Material: The 14?week long training programme with 52 participants/spokes from across India had weekly hour?long online sessions comprising of an expert?led didactic and case discussions by spokes. Online evaluation (pre? and post?training, post?session), weekly and post?one?year feedback were conducted. Successful spokes attended a hands?on workshop subsequently. Statistical Analysis Used: One and independent sample t?tests determined the significance of the evaluation scores of the participants. Findings on attitudes and practice?related questions are presented as simple percentages. Results: A notable increase in the overall and per?session mean knowledge score, and confidence in oral cancer screening was observed. Many participants started these services at their clinics, thereby reducing further referrals, and were also motivated to spread community awareness about the same. Conclusion: This tele?mentoring programme, based on the novel Extension for Community Healthcare Outcomes model, is the first oral cancer screening training programme for dentists. This model—comprising of expert didacts, case discussions, and significant spoke?expert interaction—is a promising best?practices tool for reducing the disparity in knowledge and skills regarding oral cancer prevention among dentists across different locations. This would enable these most appropriate healthcare providers to contribute toward the overall goal of oral cancer prevention

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Ethical aspects involving the use of information technology in new surgical aplications: telesurgery and surgical telementoring / Aspectos éticos relacionados con el uso de información tecnológica en nuevas aplicaciones quirúrgicas: tele-cirugía y tele-tutoría / Aspectos éticos envolvendo o uso de tecnologia da informação em novas aplicações cirúrgicas: telescirurgia e telemonitoria cirúrgica

Abstract: Background: The surgical telementoring is a technology that involves surgical procedures guided by an expert or mentor, performed by other surgeons from a distance, using information and knowledge technologies. This therapeutic innovation has generated new opportunities to improve the surgical attention and the training of the surgeons. However, their ethical implications should be analyzed to clarify their use, to check the patient's safety and eliminate uncertainties. The characteristics of surgical telementoring generate specific challenges and ethical dilemmas that must be identified, analyzed and solved. Results: In this paper the ethical challenges and dilemmas of surgical telementoring identified and analyzed cover multiple aspects such as patient safety, privacy and vulnerability, the surgeon-mentor-patient relationship and informed consent, professional responsibility, cost-effectiveness analysis and Solidarity and social justice regarding the use of healthcare resources, the systematic approach to validation of the proposed new technology and conflicts of interest. For many of these issues solutions are provided, but they are still to be solved. Conclusions: surgical telementoring potentially improves patient healing and surgeon education. It will have a rapid evolution in the next years. This rapid growth should not be anticipated to the solid implantation of ethical guarantees for its use due to the particular characteristics that this technology has in the field of telemedicine.

Resumen: Antecedentes: El uso de tele-tutoría en cirugía es una tecnología que incluye procedimientos quirúrgicos guiados por un experto o tutor, realizado por otros cirujanos a distancia usando tecnologías de información y conocimiento. Esta innovación terapéutica ha generado nuevas oportunidades para mejorar la práctica de cirugía y la formación de los cirujanos. Sin embargo, deberían de analizarse sus implicaciones éticas para clarificar su uso, comprobar la seguridad del paciente y eliminar incertidumbres. Las características de la tele-tutoría en cirugía generan desafíos específicos y dilemas éticos que deben identificarse, analizarse y resolverse. Resultados: En este artículo se identificaron y analizaron múltiples aspectos en cuanto a desafíos éticos y dilemas de tele-tutoría en cirugía tales como: seguridad del paciente, privacidad y vulnerabilidad, la relación cirujano-tutor-paciente y el consentimiento informado, la responsabilidad profesional, análisis de costo-efectividad, solidaridad y justicia social respecto al uso de recursos en el cuidado de la salud, la aproximación sistemática para la validación de la nueva tecnología propuesta y los conflictos de interés. Para muchos de estos temas se han proporcionado soluciones, pero todavía no han sido resueltas. Conclusiones: La tele-tutoría en cirugía mejora potencialmente la sanación del paciente y la educación del cirujano. Va a tener una rápida evolución en los próximos años. Este rápido crecimiento no debería anticiparse a la implantación sólida de garantías éticas para su uso debido a las características particulares que tiene esta tecnología en el campo de la tele-medicina.

Resumo: Fundo: A cirurgia teleguiada é uma tecnologia que envolve procedimentos cirúrgicos, guiados por um especialista ou mentor, executados por outros cirurgiões à distância, usando tecnologias da informação e do conhecimento. Esta inovação terapêutica tem gerado novas oportunidades para melhorar a atenção cirúrgica e a formação dos cirurgiões. No entanto, suas implicações éticas devem ser analisadas para esclarecer seu uso, para verificar a segurança do paciente e eliminar as incertezas. As características da cirurgia teleguiada geram desafios específicos e dilemas éticos que devem ser identificados, analisados e resolvidos. Resultados: Neste artigo os desafios éticos e dilemas da cirurgia teleguiada identificados e analisados vislumbram vários aspectos como a segurança do paciente, sua privacidade e vulnerabilidade, o relacionamento paciente-cirurgião-mentor e consentimento informado, responsabilidade profissional, análise custo-eficácia e solidariedade e justiça social em relação ao uso dos recursos de saúde, a abordagem sistemática para validação da tecnologia nova proposta e conflitos de interesse. Para muitas destas questões são fornecidas soluções, mas muitas ainda estão para serem resolvidas. Conclusões: a cirurgia teleguiada potencialmente melhora o atendimento do paciente e o ensino do cirurgião. Vai ter uma rápida evolução nos próximos anos. Este rápido crescimento não deve ser antecipado para a implantação contínua de garantias éticas para seu uso devido as características particulares que esta tecnologia tem no campo da telemedicina.

Application of Virtual, Augmented, and Mixed Reality to Urology / 대한배뇨장애요실금학회지

Recent developments in virtual, augmented, and mixed reality have introduced a considerable number of new devices into the consumer market. This momentum is also affecting the medical and health care sector. Although many of the theoretical and practical foundations of virtual reality (VR) were already researched and experienced in the 1980s, the vastly improved features of displays, sensors, interactivity, and computing power currently available in devices offer a new field of applications to the medical sector and also to urology in particular. The purpose of this review article is to review the extent to which VR technology has already influenced certain aspects of medicine, the applications that are currently in use in urology, and the future development trends that could be expected.

Telementoring systems in the operating room: a new approach in medical training / "Telementoring" en el quirófano: un nuevo enfoque en la formación médica

This paper discusses the challenges and innovations related to the use of telementoring systems in the operating room. Most of the systems presented leverage on three types of interaction channels: audio, visual and physical. The audio channel enables the mentor to verbally instruct the trainee, and allows the trainee to ask questions. The visual channel is used to deliver annotations, alerts and other messages graphically to the trainee during the surgery. These visual representations are often displayed through a telestrator. The physical channel has been used in laparoscopic procedures by partially controlling the laparoscope through force-feedback. While in face to face instruction, the mentor produces gestures to convey certain aspects of the surgical instruction, there is not equivalent of this form of physical interaction between the mentor and trainee in open surgical procedures in telementoring systems. Even that the trend is to perform more minimally invasive surgery (MIS), trauma surgeries are still necessary, where initial resuscitation and stabilization of the patient in a timely manner is crucial. This paper presents a preliminary study conducted at the Indiana University Medical School and Purdue University, where initial lexicons of surgical instructive gestures (SIGs) were determined through systematic observation when mentor and trainee operate together. The paper concludes with potential ways to convey gestural information through surgical robots.

Este artículo discute los desafíos e innovaciones relacionadas al uso de sistemas de tutoría en telecirugía (telementoring). La mayoría de los sistemas presentados se basan en tres tipos de canales de interacción: auditivo, visual y físico. El canal auditivo permite al instructor instruir verbalmente al alumno, y a este último hacer preguntas. El canal visual es usado para transmitir al alumno anotaciones, alertas y otro tipo de mensajes gráficos durante la cirugía. Estas representaciones visuales aparecen en un marcador de vídeo (telestrator). El canal físico ha sido usado en cirugías laparoscópicas por medio de retroalimentador de fuerza (forcefeedback). Mientras que en la instrucción cara a cara, el instructor hace gestos para transmitir ciertos aspectos de la instrucción quirúrgica, esta forma de interacción no tiene un equivalente en la interacción entre instructor y alumno en sistemas de telementoring. Si bien la tendencia es conducir procedimientos mínimamente invasivos (MIS) con estos sistemas, se deben tener en cuenta cirugías de trauma, todavía necesarias, especialmente donde la resucitación inicial y estabilización del paciente es un tema crítico y urgente. Este artículo presenta un estudio preliminar conducido en la Escuela de Medicina de Indiana (EE.UU.) y en la Universidad Purdue, donde el vocabulario de gestos (lexicons) usados en instrucción quirúrgica (SIGs) se determinaron por medio de observaciones sistemáticas mientras el instructor y el alumno operaban juntos. Se concluye discutiendo maneras alternativas de presentar esta información de gestos por medio de robots quirúrgicos.